What are older people prepared to do to avoid falling? A qualitative study in London

Abstract

Falls prevention strategies form a significant part of recent government policy relating to older people. In this article we report a qualitative study to examine the extent to which older people are willing to adopt any of the following strategies in order to avoid falling: balance and lower limb strengthening exercises, home safety advice, and ‘taking care’. A sample of community-dwelling inpatients who were more or less afraid of falling were interviewed. Some older people blamed their own unsafe behaviour rather than hazards in their home for falls, so taking care (moving slowly, holding on, being vigilant to and avoiding danger) was a widespread strategy. The benefits of exercise in falls prevention were poorly understood and there was little enthusiasm for exercising especially if it was perceived to be inappropriate in old age or painful. Awareness of home hazards and taking measures against them was common but home visits tended to be regarded as intrusive. Inadequate negotiation about adaptations was widespread and led to resentment and unwillingness to cooperate. Building on the widespread ‘taking care’ strategy may help educate older people in safe behaviour. Health professionals should encourage older people to exercise and when making home safety visits should confer with their clients, taking their preferences about adaptations into account.

Attitudes and Beliefs That Predict Older People's Intention to Undertake Strength and Balance Training

“…Coping appraisal was based on an evaluation of the many potential benefits of SBT, including enjoyment of the activity and improvement in general health, mood, confidence, and the ability to get out and about-as well as a reduction in the risk of a fall. As predicted from qualitative research (Cameron & Quine, 1994;Simpson et al, 2003;Yardley, Donovan-Hall et al, 2006), the respondents' intention to carry out SBT was strongly associated with the belief that SBT was an appropriate activity for someone like themselves, and that their family, friends, and doctor considered SBT to be suitable for them. Concerns about whether the SBT exercises would be Notes: Participant characteristics are shown as n, with % of total sample in parentheses; scale distributions are median and interquartile range.…”

“…Qualitative studies have provided some insights into what factors may be relevant (McInnes & Askie, 2004). It appears that few older people are actually aware of the potential of SBT exercises to reduce falling risk, and most assume that falls prevention entails restricting activity and using aids, which they are often reluctant to do (Commonwealth Department of Health and Aged Care, 2001;Simpson, Darwin, & Marsh, 2003;Yardley, Donovan-Hall, Francis, & Todd, 2006). Older people may resist advice to undertake falls prevention measures because the idea that they are at an increased risk of falling is incompatible with their self-image as capable and independent (Health Education Board for Scotland, 2003;Yardley, Donovan-Hall et al).…”

“…Consequently, the prediction of intentions and behavior may be improved by also assessing relevant aspects of social identity-most importantly, the extent to which the individual considers the behavior to be appropriate for someone like himself or herself (Terry et al, 1999;. Qualitative research into attitudes toward falls prevention suggests that social identity may be particularly relevant, because a common reason older people give for refusing to participate in falls prevention activities is that they are inappropriate for people like them (Cameron & Quine, 1994;Simpson et al, 2003;Yardley, Donovan-Hall et al, 2006). This attitude can arise when older people view themselves as too young and fit to need to undertake falls prevention activities, or conversely when they consider themselves too old and frail to be able to carry them out or benefit from them.…”

The FARE: A new way to express FAlls Risk among older persons including physical activity as a measure of Exposure

“…This reduction in exposure can be interpreted as a behavioral mechanism whereby subjects try to remain in control of their balance as they experience increased difficulty controlling balance. By avoiding involvement in certain physical activities, for instance due to fear of falling, they reduce demands on their balance control (Deshpande et al, 2008;Zijlstra et al, 2007;Yardley et al, 2006;Simpson et al, 2003), thereby reducing their falls risk substantially from a relative strong exponential to a moderate linear increase as balance control difficulty increases. This finding questions the suitability of the falls risk measure expressed per 1000 person-years because it is insensitive to exposure reduction among subjects who experience balance control difficulty.…”

“…Thus reducing exposure to hazards could be seen as a behavioral response to perceived difficulties controlling balance in order to maintain balance control (Laybourne et al, 2008;Wijlhuizen et al, 2008a,b). In fact, the person seems to be preventing falls (Wijlhuizen et al, 2007) and also perceives this as a way of preventing falls (Yardley et al, 2006;Simpson et al, 2003).…”